New Twist on Medical Tourism; American Surgeon Travels to Cancun Hospital

I have posted a number of blog notes over the years about medical tourism. The options when seeking medical care abroad have taken many twists and turns (see, for example: Medical Tourism Business Model in Thailand Extends to Airport Facilities; A Competitive Threat to U.S. Healthcare in the Cayman Islands?). The latest twist entails having an American orthopedic surgeon travel to a Mexican hospital to perform the operation (see: A Mexican Hospital, an American Surgeon, and a $5,000 Check (Yes, a Check)), Below is an excerpt from an article on this topic:

For...[her knee replacement],...[Donna Ferguson] would not only receive free care, but would receive a check when she got home. The hospital costs of the American medical system are so high that it made financial sense for both a highly trained orthopedist from Milwaukee and a patient from Mississippi to leave the country and meet at an upscale private Mexican hospital for the surgery. Ms. Ferguson gets her health coverage through her husband’s employer, Ashley Furniture Industries. The cost to Ashley was less than half of what a knee replacement in the United States would have been. That’s why its employees and dependents who use this option have no out-of-pocket co-pays or deductibles for the procedure; in fact, they receive a $5,000 payment from the company, and all their travel costs are covered. Dr. Parisi, [the orthopedic surgeon] who spent less than 24 hours in Cancún, was paid $2,700, or three times what he would have received from Medicare, the largest single payer of hospital costs in the United States....

In a new twist on medical tourism, a Denver company is tapping into this market. The company, North American Specialty Hospital, known as NASH, has organized treatment for a couple of dozen Americans at Galenia [Hospital in Cancun] since 2017. Dr. Parisi, a graduate of the Mayo Clinic, is one of about 40 orthopedic surgeons in the United States who have signed up with NASH, to travel to Cancún on their days off to treat American patients. NASH is betting that having an American surgeon will alleviate concerns some people have about going outside the country, and persuade self-insured American employers to offer this option to their workers to save money and still provide high-quality care. NASH, a for-profit company that charges a fixed amount for each case, is paid by the employer or an intermediary that arranged the treatment. 

So what could be wrong with this model -- the patient has the advantage of an American-trained surgeon, the procedure takes place in a private clinic in Cancun, Mexico, and the patient gets paid $5,000 for doing so. Here's why I think that there are some special risks associated with the process:

• First of all, and some patients may not understand this, the success of any complex operation rests not totally in the hands of the surgeon but also on the backs of the surgical team. This obviously includes the anesthesiologist and the OR nurses, Such a well-oiled team approach is not possible when the American surgeon flies in for the surgery and then departs. Post-operative care would be delivered by a physician different than the operating surgeon.
• Similarly, post-operative rehabilitation in the case discussed would be delivered, in part, when the patient returns to the U.S. For knee and hip replacements, skilled rehab is critical to the long term functionality of the operated joint. Not sure from the article how this is accomplished.
• For the surgery described above, I suspect that the surgeon was relatively young. I say this because he was willing to fly to Cancun for a single day. For an older surgeon with a busy practice, this wold not make economic sense.
• Younger surgeons are often better trained in newer operative procedures. What they generally lack is broad experience as evidenced by performing a particular procedure at least 100 times. For complex joint replacement, I wold personally choose a surgeon who has performed the procedures very frequently and competently.

The bottom line for me is that I would probably prefer to have a joint replacement performed by an experienced Thai orthopedic surgeon at Bumrungrad International Hospital in Bangkok than a young American surgeon who flies into Cancun for only that one procedure.